Currently, surgical skills teaching in medical schools and hospitals is changing, requiring the development of new tools to focus on (i) the importance of the mentor’s role, (ii) teamwork skills training, and (iii) remote training support. Collaborative Networked Virtual Surgical Simulators (CNVSS) allow collaborative training of surgical procedures where remotely located users with different surgical roles can take part in the training session. To provide successful training involving good collaborative performance, CNVSS should guarantee synchronicity in time of the surgical scene viewed by each user and a quick response time which are affected by factors such as users’ machine capabilities and network conditions. To the best of our knowledge, the impact of these factors on the performance of CNVSS implementing hybrid client–server architecture has not been evaluated. In this paper the development of a CNVSS implementing a hybrid client–server architecture and two statistical designs of experiments (DOE) is described by using (i) a fractional factorial DOE and (ii) a central composite DOE, to determine the most influential factors and how these factors affect the collaboration in a CNVSS. From the results obtained, it was concluded that packet loss, bandwidth, and delay have a larger effect on the consistency of the shared virtual environment, whereas bandwidth, server machine capabilities, and delay and interaction between factors bandwidth and packet loss have a larger effect on the time difference and number of errors of the collaborative task.

Stand-alone and networked surgical simulators based on virtual reality have been proposed as a means to train surgeons in specific surgical skills with or without expert guidance and supervision. However, a surgical operation usually involves a group of medical practitioners who cooperate as team members. To this end, CNVSS have been proposed for the collaborative training of surgical procedures in which users with different surgical roles can take part in the training session. To be successful, these simulators should guarantee synchronicity, which requires (1) consistent viewing of the surgical scene and (2) a quick response time. These two variables are affected by factors such as users' machine capabilities and network conditions. As far as we know, the impact of these factors on the performance of CNVSS has not been evaluated. In this paper, we describe the development of CNVSS and a statistical factorial design of experiments (DOE) to determine the most important factors affecting collaboration in CNVSS. From the results obtained, it was concluded that delay, jitter, packet loss percentage, and processor speed have a major impact on collaboration in CNVSS.

The availability of inexpensive and powerful graphics cards as well as fast Internet connections make networked virtual environments viable for millions of users and many new applications. It is therefore necessary to cope with the growing heterogeneity that arises from differences in computing power, network speed, and users' preferences. This paper describes an architecture that accommodates the heterogeneity while allowing a manager to define systemwide policies. One of the main objectives of our scheme is to allow slower nodes to participate in the session by preventing fast nodes from flooding slow nodes with too many messages. Policies and users' preferences can be expressed as simple linear equations forming a model that describes the system as a whole as well as its individual components. When solutions to this model are mapped back to the problem domain, viable solutions that accommodate heterogeneity and system policies are obtained. For example, slower nodes may receive less frequent updates than faster ones for one or several information streams. The results of our experiments with a proof-of-concept system are described.